OPHTE #14 -5- �.�%,j Harnett County Department of Public Health 23170
PERMIT # Operation Permit
New Installation X Septic Tank Nitrification Line El Repair ❑ Expansion
\ PROPERTY LOCATION:TrA r_E+ Q
Name: (owner) i i—i- �,�- `-'t Q �,e5 SUBDIVISION _ ti")0 •,s pa ti ii, LOT #
System Installer=oNc� j ,r_ e.:2°-j ,'. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 2
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I C) feet
System Type: i Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
1 Lllilll W11UMV1 13.
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ca tp is property.
Type of system: ❑ Conventional Other CA) t�\"_96X , (Q Septic Tank: ! gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Fie ditches ! of each ditch IQ5 feet ditches feet ditches a 'A°30 inches
French Drain Required: Linear feet
Authorized State Agent Date
,' 4 - S- 3)j -a,)